A 58-year-old man who underwent Billroth II gastrectomy two years ago presents with cramping epigastric pain and abdominal distension beginning 30 minutes after meals, followed by sudden bilious vomiting that relieves the pain. What is the diagnosis?
- A Early dumping syndrome
- B Roux stasis syndrome
- C Afferent loop syndrome ✓
- D Alkaline reflux gastritis
Correct answer: C. Afferent loop syndrome
Explanation
In Billroth II reconstruction the afferent limb carries bile and pancreatic juice; partial obstruction causes distension of the limb with colicky pain and mass effect, then forceful bilious vomiting that decompresses it and relieves pain. Dumping features vasomotor symptoms without relief by bilious vomiting, Roux stasis causes food retention in the efferent limb, and alkaline reflux gastritis causes continuous burning pain rather than episodic colic.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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